The Agency for Healthcare Research and Quality (AHRQ) summit entitled "Improving Health Care Quality for All Americans—Celebrating Success, Measuring Progress, Moving Forward" was held on April 4, 2005. Below is a transcript of the video summary of this summit.
Dr. Carolyn M. Clancy: In April 2005, the Agency for Healthcare Research and Quality convened its first national summit on the quality of health care in America. Leaders from throughout the health care system were on hand to look at how far we've come in measuring quality, and how we can translate what we know into better quality practices at hospitals and doctors' offices throughout our country. These health care leaders confirmed that there is a growing understanding of what we mean by quality and what we need to do to improve it. Not just a vague goal that can't be measured and not, as some used to think, merely the most expensive care. High quality health care means the right care at the right time to address the patient's needs. That may be a preventive service or a medication or coordinated care for a chronic condition. The important fact is that we're learning more every day based on evidence and research what "the right care" is for specific conditions—what works best. But we're still a long way from putting what we know into practice in every health care setting.
Dr. Carolyn Clancy (as a soundbite): Let's state our predicament right up front: When it comes to quality and health care delivery, we actually do have many answers, answers about best practices, answers about what works, proven science-based answers. What we don't have yet is results.
Dr. Clancy (as voiceover): There was a sense of urgency at the Summit because focusing on quality can help us address so many problems in our health care system, including costs. Quality of care is cost effective care. When we use what works we're getting our money's worth. It means not wasting our resources through overuse or mistakes or by letting a patient's health problems build up and become more expensive because of underuse of care. It's estimated that a third or more of our health care spending may be wasted or preventable. That means hundreds of billions of dollars every year not to mention poorer health for our patients. The quality approach is about doing better with the resources we have. Don Berwick talked about the help that our health professionals need.
Don Berwick: But most of all I think we need technical help. If we make knowledge for improvement a proprietary good, if we make it ownable and hideable, we will without any doubt in my mind at all slow progress in this country. I think that would happen even among our major medical centers which could be far more efficient in improving their care if they share knowledge about improvement at the process level the way they do at the science level. But it's definitely going to be true of the thousands of rural hospitals, the tens of thousands of doctors and three and four person practices, the many, many sites that simply are not going to be able to rediscover time after time, the process improvement sciences that AHRQ could help them get to.
Dr. Clancy: The main purpose of the Summit was to learn from each other, and some of the most important participants were on a panel called "Reports from the Field." This panel brought perspectives from different circumstances and different parts of the country, from Mississippi to New York, from Virginia to California.
Dr. Janice Bacon: This was a different approach for us in that we were used to doing audits and quality assurance sessions and looking at individual patients. But was only by becoming a part of this process we were able to say on any given day, what is the average hemoglobin A1C for the patient population you serve?
Dr. Clancy: Dr. Janice Bacon is director of clinical services for the Carmichael Family Health Center in Canton, Mississippi serving a low income area with 40 percent uninsured and very high rates of diabetes and asthma. The Center used proven quality approaches to improve health outcomes, not expensive treatments but better use of information, patient involvement and better teamwork in the clinic to get better health results.
Dr. Bacon: This is just an example of the model that we were trained on. It was initially known as the chronic care model. We're calling it more and more now the plan care model, in that it gives you a schematic of all the components involved in achieving these positive outcomes. So you have to look at the community, you're looking at your organization. The key to it is you're trying to make sure you have a proactive prepared patient on one side and an informed team ready to work on the other so that you can achieve these positive outcomes.
Dr. Clancy: The Carmichael Center improved quality with a patient-centered measurement-based approach. Not only did they regularly measure how their patients were doing, they also involved the patients closely with their own treatment and progress. And they used evidence-based guidance as targets for this progress. They built teamwork in the clinic staff and they reached out to the entire community to help support the patients in managing their conditions.
Dr. Bacon: We also decided we needed to work with the mayors and the sheriffs and all the elected officials, because it is very important to have the mayor of a town come to your health fair and shake the hands of those people there and say I'm glad you're working on your diabetes or I'm a diabetic, or my mother is a diabetic, or for the sheriff to do the same thing. So we had them come and greet the clients and that increased the value of this condition for the entire community.
Dr. Clancy: These are not expensive steps, but in this case they improved health status in one of the nation's poorest regions. Dr. Robert Panzer came from a very different facility, the 739-bed Strong Memorial Hospital in Rochester New York. Strong Memorial's approach was also patient centered with a daily goal sheet for each patient. In addition, defined systematic approaches were important along with focusing on specific problem areas.
The hospital also used health information technology with a basic IT product that was modified to be user friendly for their staff. For ventilator-associated pneumonia these approaches reduced mortality to near zero, with annual savings in the hundreds of thousands of dollars. Better quality, lower costs. Health information technology is important for quality improvement.
JoEllen Ross talked about the challenges faced by doctors in adopting health IT. She's president of Lumetra, working with the Medicare program to help small-practice physicians adopt electronic health records. The best known benefit of health IT is its ability to deliver a complete up-to-date patient record when and where it's needed. But health IT will also do more—it can deliver clinical information at the bedside, helping the clinician get the treatment right. And with information and electronic formats we'll have access to much more data to build our evidence research base, meaning we'll learn more and faster about what works best.
Dr. Gary Yates of Sentara Health Care talked about specific steps for creating a "culture of health care quality." Sentara looked at industries outside of health care to see how they have improved quality. Communications and teamwork were the first step and attention to detail was next in creating a quality culture. Sentara devised specific processes for its staff and it put a special emphasis on the hazards of transition periods—when one medical team hands off to another, or a patient is discharged.
The power of the metrics, setting specific goals and measuring results, the importance of team work, the promise of health IT, and the need to make care truly patient-centered were some of the key lessons at the Summit. Speakers also made clear that our payment and benefit policies can actually undermine quality, unless they are geared to reward results, or at least avoid punishing quality care. And two more over-arching themes that are closely engrained with quality of care: health care disparities and disease prevention. AHRQ's annual report on quality of care includes a companion report on health care disparities because it's not really possible to understand the quality issue in America without understanding the persistent problem of health care disparities based especially on race, ethnicity and income. John Nelson, president of the American Medical Association, was one of those who said disparities must be addressed.
John Nelson: We know we can do better and we know the evidence will help us to do better. Once we have that evidence base and care about our patients, the ethics demand that we do something about it. And that is why I'm excited to announce with my colleagues that we're going to that very thing. Once we identify what the disparities are, the next issue is to try to make sure that doctors understand that the disparities occur in their practices too, not just in mine. And so what we want to do then is once we have identified these is to work together in ways we previously have not worked together to make sure that these things become something of the past.
Dr. Clancy: Of course many of the causes of health care disparities lie outside the health care system. But at the Summit a panel agreed that steps can be taken in health care to address disparities regardless of other problems facing minorities and the poor.
John Nelson: We may not be able to correct in the near future all the inequities about which you speak, but as clinicians we can absolutely change the ones where the evidence tells us what to do. If you and I were to go into the hospital tonight you ought to have the same chance to have survival as I do, or you ought to have better—you're younger than what I am. But the point is instead of getting frustrated about what we can't do we have got to be excited about what we can do. The thing of physicians and nurses and others in the health care fields can do is to make sure we use the evidence and treat all patients correctly.
Dr. Clancy: Dr. Elena Rios of the National Hispanic Medical Association talked about the needs of Latinos. And Dr. Randall Maxey of the Commission to End Health Care Disparities pointed to the importance of culture and parenting as key factors in health status. And finally, disease prevention. Our quest speaker, Arkansas Governor Mike Huckabee, talked about his own personal journey to good health and his vision for improving the health of his State.
Mike Huckabee: The culture of health means that rather than simply decide that we're going to continue to find and try to treat the diseases, we would attack the causes of them. And essentially it's lifestyle choices. Three basic behaviors are driving most of the chronic disease today: lack of exercise, obesity and tobacco addiction. And so those three particular behaviors we've targeted when we launched the Healthy Arkansas Initiative, and we decided that we would set some very specific goals to try to change the behavior and the culture and the attitudes towards those behaviors in our State.
Dr. Clancy: A few final thoughts. First, the importance of listening to the patients. A patient's perceptions of quality may not be the same as the doctor's or researcher's. But we'll be missing the point if we don't hear what patients are saying to us about what they want. And second, quality improvement can be achieved. In fact, we have a dramatic example in this year's report. Nursing homes got an early taste of quality measurement as a result of the CMS Nursing Home Quality Initiative. And the improvements in this year's report were dramatic. For the five measures of nursing home quality, performance improved by almost 15 percent in a year. There was a decrease of 37 percent in patients who have moderate to severe pain. And for nursing homes that received special and intensive help as part as the CMS Initiative, the reduction in pain was 46 percent.
This spring we've seen new progress in HHS agencies. CMS has launched its "Hospital Compare" Web site. And along with our annual quality report, AHRQ presented State-specific measures to help each State target its quality efforts where they are most needed. We're also launching a new AHRQ "Quality Connect" initiative to lend help to States. Quality of care—the right treatment at the right time for the patients needs—gives us a productive and efficient way to look at our health care system. It gives us specific goals and measurable results that add up to cost-effective care and better health.
Improving quality will mean a new culture in health care: Openness and candor above quality performance, and comparison of one provider with another. It will take courage on the part of our health care professionals, and cooperation to share the approaches that work. With all the challenges our health care system faces, the quality approach is an important, hopeful, movement. A way to make better use of our vast health care resources, a measurable means to achieve cost-effective care, and the chance to deliver proven good quality care to all Americans.
Current as of April 2005
Internet Citation:
AHRQ Summit on Improving Quality of Care. Video Summary Transcript. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/qsummit/qsumvidtr.htm
Return to Video Summary
Return to Quality Information & Improvement